Isaac Y. Kim, MD, PhD, MBA, Author at Grand Rounds in Urology

Isaac Y. Kim, MD, PhD, MBA

Yale School of Medicine

New Haven, CT

Dr. Isaac Kim is a urologic oncologist and surgeon who specializes in the treatment, management, and prevention of prostate cancer, with the goal of helping patients navigate and better understand their disease. He has expertise in minimally invasive robotic surgery and has completed more than 2,100 robotic surgeries for prostate cancer. Dr. Kim's surgical focus has been on advanced and metastatic prostate cancer, as well as recurrent disease after radiation. Dr. Kim’s clinical research is focused on mechanisms of treatment resistance and specifically immunosuppressive factors produced by prostate cancer cells. He also has a strong interest in inflammation in prostate cancer and the role of surgery in men with advanced or metastatic prostate cancer.

Disclosures:

Talks by Isaac Y. Kim, MD, PhD, MBA

Pelvic Lymph Node Dissection During Radical Prostatectomy: Should We Do It?

Posted by Isaac Y. Kim, MD, PhD, MBA | Aug 2024

Isaac Y. Kim, MD, PhD, MBA, debates the benefit of Pelvic Lymph Node Dissection (PLND) during radical prostatectomy. He suggests there is no definitive evidence on PLND’s clinical benefit, no proven survival benefit, and no effective adjuvant radiotherapy. In his experience, he counsels patients according to the marginal benefit of PLND vs risks. Kim suggests there is a controversy as there is no consensus on PLND indication. In his opinion, the cutoffs do not make sense as the risks and benefits have to weigh and balance – the debate is not necessary if the risk of PLND is minimal. He describes a patient with cautery injury to the external IAC vein, which could have been a disastrous event, suggesting most data shows EPLND is associated with increased risk of complications. When comparing outcomes of patients with limited vs extended template node dissection, there is a lot of data that shows no significant survival benefit (Lestingi et al, Eur Urol 2021). While some data shown adjuvant treatment may make some difference, in his patients at Rutgers, patients who had pathologic N1 disease, compared limited template vs. extended template (EPLND) a showed a 3 year progression free survival and subgroup analysis stratified by lymph node metastasis showed no survival benefit. He doesn’t recommend EPLND given current data, considering the 2% cutoff is too conservative, and recommends a 5-7% cutoff. He questions the ability of ongoing clinical trials to answer questions of dissection, suggesting trials must demonstrate benefits for removal and then subsequent therapy. Kim is designing a clinical trial at Yale to determine if not performing PLND is superior to performing PLND at the time of radical prostatectomy.

Cytoreductive Radical Prostatectomy – Is the Cat Already Out of the Bag? Current Status and Future

Posted by Isaac Y. Kim, MD, PhD, MBA | Jan 2024

Isaac Y. Kim, MD, PhD, MBA, discusses cytoreductive radical prostatectomy (CRP). Despite advancements, the overall survival rate for metastatic prostate cancer (the incidence of which is rising in the U.S.) has only increased by four months since 2000. Dr. Kim cites the need for a paradigm change and posits that CRP may increase survival.

Dr. Kim describes a Phase I study on CRP showing a major complication rate of six percent as well as potential oncologic benefits. He cites a pilot study on patients receiving CRP and systemic therapy with some patients having durable responses long-term after CRP. Dr. Kim summarizes key lessons from the phase-one study, that CRP is feasible but difficult and the oncological outcome is promising, with three potentially different oncologic responses to CRP, with some patients experiencing PSA nadir <0.2 ng/ml, PSA decline but nadir remains 20.2 ng/ml, or disease progression. Dr. Kim turns to the SIMCAP (Surgery in Metastatic Carcinoma of Prostate) Phase-II.5 study with the hypothesis being that CRP will render systemic therapy more effective and enhance quality of life in men with metastatic prostate cancer. He reviews endpoints, inclusion criteria, and study design and explains the study is a 1:1 randomization of surgery and systemic therapy vs. systemic therapy alone. Dr. Kim emphasizes the study’s scientific value in addition to the study's clinical value, providing access to biospecimens early in the treatment cycle. He compares the SIMCAP and SWOG clinical trial S1802, explaining that SIMCAP is purely focused on surgery and doesn't include radiation and SIMCAP will have initial data more quickly than SWOG S1802. Dr. Kim summarizes by emphasizing CRP is safe and feasible, with a promising but uncertain therapeutic value, and the phase-two result on efficacy and quality of life is expected in two to four years.